乳癌的治疗手段乳癌内分泌治疗的发展HormoneTherapyResponseRate(%)inDifferentReceptorStatusSurvivalbyResponseArimidex1mgMAAGTamoxifenfor5YearsvsNoTreatmentTamoxifenAdjuvantTherapyforEBC辅助内分泌治疗的决定因素是激素受体状况ER阳性效果最好TamoxifenAdjuvantTherapyforEBC合适的TAM服药时间为5年TamoxifenAdjuvantTherapyforEBCER阳性无论年龄大小都可用TAMTamoxifenAdjuvantTherapyforEBC降低对侧乳癌发生增加子宫内膜癌的风险TamoxifenAdjuvantTherapyforEBCER阳性TAM和化疗合用比单用TAM更有效CAF与TAM序贯合用比同时效果更好MAAGSurvivalDataAnastrozole/MA瑞宁得(Arimidex)比MA更有效、更安全PreventionDCIS/NeoadjAnastrozoleisSuperiortoTamoxifeninFirstLineTherapy（0030）*Hazardratio(tam:‘Arimidex’)1.44,lowerCL1.16.Study‘powered’forequivalence.Medianfollow-upof18months.71%progressedAIsisSuperiortoTamoxifenasFirst-lineTherapyforAdvancedBreastCancerPreventionDCIS/NeoadjRationaleforAdjuvantTherapyWithAromataseInhibitors(AIs)TheGoldStandardMilestonesActivated1996Plannedaccrual9366AccrualtodateClosed1999Kaplan–MeierCurvesofDisease-freeSurvivalinITTPopulationKaplan–MeierCurvesofDisease-freeSurvivalinReceptor-positivePopulationPredefinedadverseevents*HotflushesAvsTCvsTAvsCTheATACEarlybreastcancertrialinpostmenopausalpatientsEndometrialsub-protocolresultsDemographicsBaselineUltrasoundAvsTCvsTAvsCATACSummaryConclusionsAnalysisoftheIncidenceofNew(Contralateral)BreastPrimariesWhyuseanAromataseInhibitor?ATAC:incidenceofnew(contralateral)breastprimariesinITTpopulationWomen-yearsoffollow-upperarm3100x2.8=8600Rateofcontralateraltumoursinwomennottreatedwithtamoxifen(women-years)ExpectedcontralateraltumoursObservedontamoxifen46%reductionObservedon‘Arimidex’77%REDUCTIONIBISITamoxifeninpreventionIBISII:PreventionIBISII:DCISNSABPPreventionDCIS/Neoadj绝经前乳癌内分泌治疗卵巢切除加口服依西美坦治疗绝经前乳腺癌骨转移长期缓解Zoladex诺雷得用于绝经前乳腺癌患者的治疗Zoladex与卵巢切除术治疗复发转移乳癌效果比较Zoladex3.6mg用于绝经前进展期乳腺癌II期临床试验KlijnJGM,etal.JClinOncol2001;19:343–53.Overalllogranktest:p=0.0114Zoladex=卵巢切除术Zoladex+TAM>ZoladexArimidex>TAMZoladex+Arimidex诺雷得+瑞宁得诺雷德+瑞宁得治疗绝经前患者ARandomizedTrialofZoladex+TAMvsZoladex+Arimidexinper/perimenopausalpatientswithhormonedependentABCZ